NPIMap

Organization Active NPI

Michael J. Athans, PH.D. and Associates, LTD.

  • Clinical Psychologist
  • Park Ridge, IL
National Provider Identifier
1235100140
Registry record updated Nov 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071003398 Issued in IL
Legal business name
MICHAEL J. ATHANS, PH.D. AND ASSOCIATES, LTD.
Practice address
32 Main St
Suite D
Park Ridge, IL 60068-4060
Phone
(847) 823-4444
Fax
(847) 823-4456
NPI assigned
Jan 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael James Athans, PH.D.NPI 1760499610
Title
Director
Phone
(847) 823-4444

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 071003398 IL Primary

Addresses

Primary practice location

32 Main St
Suite D
Park Ridge, IL 60068-4060

Mailing address

32 Main St
Suite D
Park Ridge, IL 60068-4060
Phone (847) 823-4444

Other identifiers 1

IdentifierTypeStateIssuer
01633134OtherILBLUE CROSS PROVIDER NUMBE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051031000842 IL Part B Supplier - Clinic/Group Practice 3678590429 Receives reassigned benefits from 6 practitioners
Practice locations: Park Ridge, IL

National Provider Directory

National Provider Directory

Locations

32 Main St
Ste D
Park Ridge, IL 60068
Phone (847) 823-4444

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320710400000",
    "number": "1235100140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 MAIN ST",
            "address_2": "SUITE D",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600684060",
            "telephone_number": "847-823-4444",
            "fax_number": "847-823-4456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 MAIN ST",
            "address_2": "SUITE D",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600684060",
            "telephone_number": "847-823-4444",
            "fax_number": "847-823-4456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL J. ATHANS, PH.D. AND ASSOCIATES, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-30",
        "last_updated": "2011-11-08",
        "status": "A",
        "authorized_official_last_name": "ATHANS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "847-823-4444",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071003398",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "01633134",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Ridge, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.